Crazy ICU nights...

Ruby Vee, BSN · Sep 14, 2009

long, (well not so long) ago and far away, my patient, whom i'll call wong, had a thoratec biventricular assist device. thoratecs were relatively new, and he was only the second patient in our facility to have one. wong had had a minimally invasive off-pump heart surgery that had gone horribly wrong, and he was brought to our unit with the device, and a heart rhythm best described as deadly: ventricular fibrillation. after we got over the initial discomfort with the device and the squeamishness of seeing that rhythm on the monitor, it was fun to watch other people's reactions. wong was fully medicated and totally unresponsive.

one time, i happened to be sitting at the desk right outside wong's room when our medical director brought by a group of fourth year medical students. winking at me, he led the students into the room, chatting casually to the effect of "this is one of our private icu rooms. most of our rooms are semi-private and . . . ". it was so much fun to see which medical student would look up and notice that rhythm on the monitor first and what the response would be. one girl shrieked and flipped wong's blankets off, almost beginning cpr before someone stopped her and suggested she check for a pulse. she argued until someone dragged her off the bed, and the expression when she actually felt a pulse was priceless!

eventually, all the docs would bring around groups of students, including the point of care pharmacist with his group of pharmacy students. one guy, clearly noticing the rhythm but not wanting to be the first to call attention to it kept nudging his buddies and nodding toward the monitor. his buddies were far more interested in the technology than the patient until my boss (encouraged, i must admit, by me) rushed into the room and shouted "oh my god! he's in v fib!" the newbies blanched and froze until i came in nonchalantly and said, "oh, yeah. that's his normal rhythm, " then busied myself fluffing pillows.

WindwardOahuRN, RN · Sep 14, 2009

HEEEEELLLOO evyerone!!!!!!
Well i thought it would be fun to read about some of the crazy, gross, weird, amazing, touching, horrible, ect experiences we all have gone thu in the ICU...
I'll start...
SO I work in a 22 bed MICU/SICU. I have worked there almost 3 yrs, but only been a nurse a few months. SO, this is just somemthing i had never seen before and thought it was pretty crazy. we had a pt the other week who was a full code, but would go asystole about once q30 mins for about 10-40 seconds! it was the craziest thing. he would just be beating along and then ding-ding-ding, asystole, and we would jsut watch the monitor to make sure and to see how long it would be till he came back. he did this for almost 2 weeks before he passed.
The funny part was, after one night of this we were all used to it, but we would "get" ppl who were not aware, ask them to check what the alarm was on the monitor, have them look and start to freak out as we all sit there and say , oh, no big deal...:chuckle I guess we ahve a weird sense of humor :)

Personally I don't get what was going on here at all. No plans for permanent pacemaker insertion? Did he ever have an EPS workup? He did this for "two weeks before he passed." Lemme guess...he finally was unable to break out of asystole.

Maybe there is something that you aren't sharing here but the story as you told it really isn't funny at all.

Yep...you guys sure do have a weird sense of humor.... :confused:

vastudent09 · Sep 15, 2009

I didn't want to make the post too long, but he had terminal gastric cancer, had had multp. surgeries that were unsuccessful. there was nothing else to be done, he was trached & unresposive , becoming septic- anyway, the family would not make him a DNR, and he was not a candidate for any surgery or anything...so... after all MDs were aware, and since nothing to do...yes he stayed like that fo 2 weeks.

JGTB · Sep 15, 2009

I have a story, that of course happened on a full moon night shift in our MICU. It was around 2am and we received a patient with an extensive psych history who was admitted in with a medication overdose but was actually relatively stable medically speaking. She was starting to become very agitated and combative down in ER so she came up with full restraints (we'll leave the ethics for another post J ). During report while the nurses were just outside the room, she somehow was able to get out of her restraints very quietly- Houdini style, pull out her IV (luckily her only invasive line) and make a run for the doors. She happened to pass by a poster for an October benefit concert that had the title, "howl at the moon" and so she ran through our ICU, doing just that...howling at the top of her lungs. Luckily most of our patients were sedated and vented at the time but a few of the conscious patients were obviously frightened hearing some woman howling and running down the hallway, of course dripping blood from her peripheral IV site. As luck would have it, she didn't make it out of the unit and she ran into the break room where two nurses were "resting" with the lights out. Needless to say, these nurses were very surprised to have some patient throw open the doors, howling and yelling with a crowd of nurses in hot pursuit! The look on their faces was priceless! The patient grabbed my co-worker's coffee and starting drinking it and one nurse had the unfortunate luck of bringing her purse with her and the patient grabbed it and started rifling through it. We finally managed to calm her down and bring her back to her room after calling in some serious psych support. Obviously, this had the potential to escalate into a violent situation but it didn't, so looking back I can definitely see the humor in the situation! We won't be putting any more posters up on the wall any time soon that's for sure!

vastudent09 · Sep 19, 2009

LMAO!! how funny, I can just picture that whole situation...thanks for the post!:chuckle

highlandlass1592, BSN, RN · Sep 22, 2009

long, (well not so long) ago and far away, my patient, whom i'll call wong, had a thoratec biventricular assist device. thoratecs were relatively new, and he was only the second patient in our facility to have one. wong had had a minimally invasive off-pump heart surgery that had gone horribly wrong, and he was brought to our unit with the device, and a heart rhythm best described as deadly: ventricular fibrillation. after we got over the initial discomfort with the device and the squeamishness of seeing that rhythm on the monitor, it was fun to watch other people's reactions. wong was fully medicated and totally unresponsive.

one time, i happened to be sitting at the desk right outside wong's room when our medical director brought by a group of fourth year medical students. winking at me, he led the students into the room, chatting casually to the effect of "this is one of our private icu rooms. most of our rooms are semi-private and . . . ". it was so much fun to see which medical student would look up and notice that rhythm on the monitor first and what the response would be. one girl shrieked and flipped wong's blankets off, almost beginning cpr before someone stopped her and suggested she check for a pulse. she argued until someone dragged her off the bed, and the expression when she actually felt a pulse was priceless!

eventually, all the docs would bring around groups of students, including the point of care pharmacist with his group of pharmacy students. one guy, clearly noticing the rhythm but not wanting to be the first to call attention to it kept nudging his buddies and nodding toward the monitor. his buddies were far more interested in the technology than the patient until my boss (encouraged, i must admit, by me) rushed into the room and shouted "oh my god! he's in v fib!" the newbies blanched and froze until i came in nonchalantly and said, "oh, yeah. that's his normal rhythm, " then busied myself fluffing pillows.

omg!!! ruby, we had the same thing happen with an abiomed bi-vad...fried through his hear to the point he stayed in vfib. gosh, it was fun walking him around on the unit and people would wander in and freak asking where was that patient and we'd point to him ambulating!!! vad patients can be such amazing patients!